What To Look For In A Health Insurance Plan

What To Look For In A Health Insurance Plan

A health insurance plan is a need of modern times. Contemporary health care is getting better and more advanced with each passing year leading to an early and precise diagnosis of diseases resulting in focussed treatment. But this advancement comes at a financial cost that keeps on spiralling.

A recent report suggests, the cost of medication nearly doubles every six years leading to huge financial burden even for ordinary ailments. Health Insurance, commonly known as Mediclaim, gives you financial protection in case of big medical exigencies or routine ailments. But what should you look for before choosing a Health Insurance policy?

Cover size

Premium should never be the sole criteria for deciding which policy to buy. Choose a policy that allows you the maximum coverage with the minimum premium with all other conditions being the same. Suppose policy ‘A’ covers 8 illnesses at a yearly premium of Rs 7,000 while policy ‘B’ covers 12 illnesses for Rs 10,000. A natural tendency is to go in for policy A as it seems to be cost effective but this saving of Rs 3,000 could prove to be very costly if the insured gets afflicted by any of the 4 illnesses covered by policy B but not A.

Claim Settlement Ratio  

This is the most important factor that one should consider while taking a health plan. The CSR gives a clarity on the claims settled by the company against the claims it received in a year. The claim settlement ratio of an insurer gives you an idea of the likelihood of your claim being accepted or rejected. So go for a company that has a higher claim settlement ratio, the chances of claim rejection are less.


While choosing a Health Insurance plan, you should be extra cautious about exclusions as not all diseases and injuries are covered by all policies. Do read the fine prints and watch out for diseases which are not included. Many plans do not cover alternative treatments like Ayurveda and Homeopathy. It is best to compare different plans grab the best deal for yourself.

Hospital network

In case of a medical emergency, time is of crucial importance. So find out which insurer has tie-up with nursing homes and hospitals nearby your place of residence. Also, find out which policy offers the benefit of a cash-less facility so that you need not spend precious time in unnecessary documentation nor do you have to shell out reimbursable money at the time of medical treatment.


At the time of zeroing in on your policy ensure that the policy is portable that is you can change your health insurer without losing the waiting period benefit of the current policy? Also, keep in mind that porting is free, so do not opt for policies that charge a porting fee.

Medical history

Take a policy that is in line with your family’s medical history and one that gives you the maximum coverage against diseases your family is prone to.  If your family has a history of diabetes go in for a policy that covers diabetes or if your family’s medical history shows that members of your family are prone to heart disease go in for a policy that covers heart ailments.

Floater size

The number of family members that can be covered in a single policy varies from policy to policy and from insurer to insurer.  While deciding on the policy keep in mind your family size and their needs, age, marital status and economic position and choose the policy that best suits your needs.

 Top ups and sub-limits

Check the top up plans of various medical policies. An insurance company offers you additional cover when you exceed your threshold limit. This is called a top up plan. Take a policy with top ups most suitable for you. Similarly, study the sub-limits of various policies. These policies generally come with limits on various expenses like hospital room, cost of medicines, daily expenses etc. and zero in of a policy that is likely to give you maximum benefit.

Waiting Period

A waiting period is the cooling period when the insurance company is not bound to pay out any claim made by a policyholder. The waiting period for a plan begins from the day you buy a policy and is normally for 30 days. It is important to note here that if a disease is diagnosed for the first time during this period, then it won’t be taken as a pre-existing disease. Do read through the policy and try to go for the one which has the shortest waiting period.

No Claim Bonus

You are rewarded with an either increased sum insured or a discount on the renewal premium if you do not register or make any claims during the policy period. This is called no claim bonus.

Free-look Period

This enables you to return the policy within 15 to 30 days of buying it and get a refund if you are not satisfied with the plan. Do go through all the details once the policy is in your hand to ensure you have got what you need. In case you feel there is something missing, then make use of this window and return the policy.

There is a number of options available in the market when it comes to Health Insurance policy. While buying one for yourself, do make a comparison of the products available based on the factors discussed above.


Source by:-bankbazaar